Provider Demographics
NPI:1003982208
Name:NEUROLOGY CLINIC, P.C.
Entity Type:Organization
Organization Name:NEUROLOGY CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TENESHIA
Authorized Official - Middle Name:K
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-333-2626
Mailing Address - Street 1:1325 MCFARLAND BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35476-3270
Mailing Address - Country:US
Mailing Address - Phone:205-333-2626
Mailing Address - Fax:205-333-8718
Practice Address - Street 1:1325 MCFARLAND BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35476-3270
Practice Address - Country:US
Practice Address - Phone:205-333-2626
Practice Address - Fax:205-333-8718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL8700174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-11377OtherBCBS
AL510-11377OtherBCBS